Perspectives of operative endoscopy in fetal medicine

SummaryIn this review the indications, techniques, results and perspectives of operative fetoscopy are described and discussed. Prenatal invasive therapy is indicated if postnatal therapy comes too late and fetal disease may lead to irreversible damage or death if it is left untreated. Potential candidates for intrauterine surgery are pregnancies with the following problems: diaphragmatic hernia, infravesical obstruction, sacrococcygeal teratoma, chorioangioma, neural tube defects, twin-twin transfusion syndrome and acardiac twin. The aim is to improve the intrauterine situation by minimally invasive surgery and to prevent irreversible damage. After delivery permanent repair is possible in cases with fetal malformations. Diaphragmatic hernia is the best example for the development from maximally invasive open fetal surgery to minimally invasive endoscopic surgery. There is still a lot of experimental work to be done, for example for the correction of diaphragmatic hernia and neural tube defects. However, in other areas such as severe second trimester twin-twin transfusion syndrome, endoscopic surgery is a well established technique in certain centres for fetal medicine. Endoscopic laser coagulation of the vascular placental anastomoses is a causal therapy and shows better results than serial amniodrainages. After 160 laser coagulations performed in our institution, the survival rates are as follows: overall 68 % of fetuses, with two survivors in 54 % and at least one survivor in 83 % of pregnancies.